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Graefe's Archive for Clinical and Experimental Ophthalmology
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 7/2017

01-07-2017 | Review Article

Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review

Authors: Rupa Patel, Stephen Charles, Assad Jalil

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 7/2017

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Abstract

Purpose

To survey current practice and opinion regarding the cessation of antiplatelet and anticoagulant agents prior to vitreoretinal surgery, with special emphasis on novel anticoagulants, and to provide an overview of current literature.

Methods

An online survey was sent to 167 members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). A literature search and analysis was conducted on studies that reviewed the bleeding risk of antiplatelet and anticoagulant agents.

Results

The majority (93% for aspirin, 82% for clopidogrel) of respondents would not suspend antiplatelet administration, and 79% would not stop warfarin before vitreoretinal surgery. Regarding the novel anticoagulants (factor Xa inhibitors), 58% would not stop them, and 24% were unsure. Eighty-three percent of the surgeons were not confident regarding the management of factor Xa inhibitors preoperatively. Thirty-one percent of the respondents felt that anticoagulation cessation was independent of the type of vitreoretinal surgery, whereas 9% each felt that they would stop anticoagulation if possible for diabetic vitrectomy and retinectomy. Published evidence suggests that antiplatelet agents and warfarin do not confer a significantly greater risk of intra- or perioperative bleeding. Evidence regarding the novel anticoagulants is sparse.

Conclusions

Further evaluation of novel anticoagulants in vitreoretinal surgery is required in order to provide evidence-based recommendations and address variations in practice.
Literature
1.
Benzimra JD, Johnston RL, Jaycock P, Galloway PH, Lambert G, Chung AKK, Eke T, Sparrow JM, UK EPR User Group (2009) The cataract national dataset electronic multi-centre audit of 55,567 operations: antiplatelet and anticoagulant medications. Eye 23:10–16CrossRefPubMed
2.
3.
Mason JO 3rd, Gupta SR, Compton CJ, Frederick PA, Neimkin MG, Hill ML, Heersink MJ, Vail RS, White MF Jr, Feist RM, Thomley ML, Albert MA Jr (2011) Comparison of hemorrhagic complications of warfarin and clopidogrel bisulfate in 25-gauge vitrectomy versus a control group. Ophthalmology 118(3):543–547CrossRefPubMed
4.
Oh J, Smiddy WE, Kim SS (2011) Antiplatelet and anticoagulation therapy in vitreoretinal surgery. Am J Ophthalmol 151(6):934–939CrossRefPubMed
5.
De Caterina R (2009) The current role of anticoagulants in cardiovascular medicine. J Cardiovasc Med (Hagerstown) 10(8):595–604CrossRef
6.
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW, American College of Chest Physicians (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133(6 Suppl):381S–453SCrossRefPubMed
7.
Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ, American College of Chest Physicians (2008) Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133(6 Suppl):454S–545SCrossRefPubMed
8.
Kakkos SK, Kirkilesis GI, Tsolakis IA (2014) Efficacy and safety of the new oral anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban in the treatment and secondary prevention of venous thromboembolism: a systematic review and meta-analysis of phase III trials. Eur J Vasc Endovasc Surg 48(5):565–575CrossRefPubMed
9.
Miesbach W, Seifried E (2012) New direct oral anticoagulants–current therapeutic options and treatment recommendations for bleeding complications. Thromb Haemost 108(4):625–632CrossRefPubMed
10.
Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, Hart JC, Herrmann HC, Hillis LD, Hutter AM Jr, Lytle BW, Marlow RA, Nugent WC, Orszulak TA (2004) ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 110:e340–e437
11.
Ing E, Douketis J (2014) New oral anticoagulants and oculoplastic surgery. Can J Ophthalmol 49(2):123–127CrossRefPubMed
12.
13.
14.
Yorston D, Wickham L, Benson S, Bunce C, Sheard R, Charteris D (2008) Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy. Br J Ophthalmol 92:365–368CrossRefPubMed
15.
Novak MA, Rice TA, Michels RG, Auer C (1984) Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology 91:1485–1489CrossRefPubMed
16.
Schachat AP, Oyakawa RT, Michels RG, Rice TA (1983) Complications of vitreous surgery for diabetic retinopathy II Postoperative complications. Ophthalmology 90:522–530CrossRefPubMed
17.
Fabinyi DC, O’Neill EC, Connell PP, Clark JB (2011) Vitreous cavity haemorrhage post-vitrectomy for diabetic eye disease: the effect of perioperative anticoagulation and antiplatelet agents. Clin Exp Ophthalmol 39(9):878–884CrossRefPubMed
18.
Tan LT, Ziahosseini K, Cormack G, Charles S (2009) Peri-operative management of antithrombotic therapy in vitreoretinal surgery. Eur Ophthalmic Rev 3(1):45–47CrossRef
19.
Brown JS, Mahmoud TH (2011) Anticoagulation and clinical significant postoperative vitreous haemorrhage in diabetic vitrectomy. Retina 31(10):1982–1987CrossRef
20.
Brillat E, Rouberol F, Palombi K, Quesada JL, Bernheim D, Albaladejo P, Aptel F, Romanet JP, Chiquet C (2015) A case-control study to assess aspirin as a risk factor of bleeding in rhegmatogenous retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 253(11):1899–1905CrossRefPubMed
21.
Ryan A, Saad T, Kirwan C, Keegan DJ, Acheson RW (2013) Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery. Clin Exp Ophthalmol 41:387–395CrossRefPubMed
22.
Narendran N, Williamson TH (2003) The effects of aspirin and warfarin therapy on haemorrhage in vitreoretinal surgery. Acta Ophthalmol Scand 81(1):38–40CrossRefPubMed
23.
Grand MG, Walia HS (2016) Hemorrhagic risk of vitreoretinal surgery in patients maintained on novel oral anticoagulant therapy. Retina 36:299–304CrossRefPubMed
24.
Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015CrossRefPubMed
25.
Malik AI, Foster RE, Correa ZM, Petersen MR, Miller DM, Riemann CD (2012) Anatomical and visual results of transconjunctival sutureles vitrectomy using subconjunctival anesthesia performed on select patients taking anticoagulant and antiplatelet agents. Retina 32(5):905–911CrossRefPubMed
26.
Passemard et al (2012) Maintenance of anticoagulant and antiplatelet agents for patients undergoing peribulbar anesthesia and vitreoretinal surgery. Retina 32:1868–1873
27.
Dayani PN, Grand MG (2006) Maintenance of warfarin anti-coagulation for patients undergoing vitreoretinal surgery. Arch Ophthalmol 124(11):1558–1565CrossRefPubMed
28.
Fu AD, McDonald HR, Williams DF, Cantrill HL, Ryan EH Jr, Johnson RN, Ai E, Jumper JM (2007) Anticoagulation with warfarin in vitreoretinal surgery. Retina 27(3):290–295CrossRefPubMed
29.
Chandra A, Jazayeri F, Williamson TH (2011) Warfarin in vitreoretinal surgery: a case controlled series. Br J Ophthalmol 95:976–978CrossRefPubMed
30.
Mueck W, Schwers S, Stampfuss J (2013) Rivaroxaban and other novel oral anticoagulants: pharmacokinetics in healthy subjects, specific patient populations and relevance of coagulation monitoring. Thromb J 11:10CrossRefPubMedPubMedCentral
Metadata
Title
Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review
Authors
Rupa Patel
Stephen Charles
Assad Jalil
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 7/2017
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-017-3664-3

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